One night, perhaps a couple of years after she was released from Mayview State Hospital, Julia Mae Dias called her sister to say someone was staring into her living-room window.
Deloris Lewis knew there was no way anybody could peer into the upper-story apartment, but she said she and her husband, Robert, went to Oakland to check on her -- and determined that Dias had been frightened by her own reflection.
"I went out and showed her my reflection, and Bob went and showed her his reflection," Ms. Lewis recalled.
If only all of Dias' troubles could have been resolved so easily.
For four years after her discharge from Mayview State Hospital, Dias, who had schizophrenia and obsessive-compulsive tendencies, struggled to adjust to life on her own. She changed homes numerous times, got into bad relationships, wandered the streets of Stowe and McKees Rocks and, in October 2009, was shot to death behind a McKees Rocks house.
The unsolved murder of Dias, who was 46, underscores the vulnerability and other challenges that former Mayview patients face in community settings. Her death also highlights the tension inherent in the mental health system's goal of caring for people with serious mental illness while allowing them to live as independently as possible.
From 2005 to 2008, state and local officials released Dias and 304 other people from Mayview so that the South Fayette hospital, which served seriously mentally ill residents of Allegheny and four other counties, could be closed.
Though officials stress that many of the former Mayview patients are doing well in community settings, about 45 have died, most from natural causes. Seven died in accidents and one of a suicide. Only one has been a homicide victim, according to HealthChoices Inc., the Downtown agency that helped plan Mayview's closure.
Allegheny HealthChoices declined to discuss Dias. So did officials of the Allegheny County Department of Human Services, which oversees services to former Mayview patients, and Mercy Behavioral Health, an agency that worked with Dias.
"They never did take care of her once she got out of Mayview," Ms. Lewis said.
Troubled since childhood
Dias was born Jan. 25, 1963, and given a name that honored both of her parents.
Her mother, Annie Mae Dias, hailed from Long Leaf, a company-owned timbering town in the pine woods of central Louisiana that faded away after the sawmill shut down in 1969.
Ms. Lewis said her mother left Long Leaf at 15 -- that would have been about 1941 -- and went to be with a relative in Pittsburgh. Here, she met Julius Dias, a Beaumont, Texas, transplant of Hispanic descent. The 1940 census showed him living in a rented house in the Lower Hill District -- the street no longer exists -- and working as a road laborer.
Julius, as much as 20 years older than his bride, had two children from previous relationships. He was an only child, while his wife hailed from a large family, Ms. Lewis said.
Julius and Annie Mae had their first child, JoAnn, in 1945. Then came Esther, Lucille, Deloris, Elmira, Josephine, Rose Lee and Julia Mae. Ms. Lewis said her father worked in a steel mill and her mom as a home-health nurse.
"I grew up happy in my family," Ms. Lewis said. "That was a joyful time for me."
But she said her baby sister struggled, not wanting to go to school and eventually dropping out, experiencing seizures and developing a mean streak that sometimes belied her big smile. Ms. Lewis wonders whether a childhood head injury -- she was dropped by one of the other girls -- had anything to do with the psychiatric disorders diagnosed later.
Dias was first treated at Mayview State Hospital and Western Psychiatric Institute and Clinic as a young adult. Ms. Lewis said her sister had a difficult time managing after her daughter was born in 1980.
Sharon Dias, now a Wilkinsburg resident with three sons, said her mother, who remained single, cared for her as best she could. But she said her mom's late-night socializing with friends, until 2 a.m. some days, interfered with her schooling.
When she was 9, she said, she moved in with Ms. Lewis and stayed until she was 17. She saw her mom only sporadically, even after her release from Mayview in 2005.
"It's a shame she had that disease," Ms. Dias said. "It basically robbed her of a normal life."
Ms. Lewis recalled looking after her niece from the time she was 4, not 9, and said Dias, who had a fixation with cleanliness, was admitted to Mayview at the time because she was excessively washing her daughter and otherwise acting oddly.
At Mayview, Ms. Lewis said, her sister got worse in some ways, staring into space for long stretches and shuffling along the hallways as other patients did.
Yet Ms. Lewis said she couldn't bring her home. She said Annie Mae had grown afraid of her ill daughter. Ms. Lewis' children were afraid, too. "She scared me a couple of times as a matter of fact," Ms. Lewis said.
A struggle to adapt
About 2005, officials at Mayview told Dias' family that they were sending her out into the world.
The hospital was being emptied so that the patients could lead more independent, regular lives in the community -- and, critics said, so the state could save money by closing the institution.
Mary Jo Dickson, the county's administrator for adult mental-health services, said community support plans were developed to address each patient's housing, psychiatric care and other needs after discharge. She said patients had input into the plans and family members, with their loved ones' consent, also had the opportunity to make recommendations.
New housing and other programs were established to serve the former patients, she said, adding that "people still should be able to get the intensity of services" they had at Mayview. If the former patients and family members had complaints, she said, there was recourse available to them.
Ms. Lewis said she had input into her sister's community support plan, but didn't believe that social workers and treatment organizations ever provided a sufficient level of care or monitoring. Another sister, Lucille Mitchell of Garfield, agreed.
"Nobody did what they were supposed to do. ... They didn't see about her," Ms. Mitchell said.
Ms. Lewis said Dias moved repeatedly, living mostly on the street at times when she had tired of an apartment, and got into relationships with men who used her for sex and her monthly disability checks.
"She accepted that because she was alone," Ms. Lewis said.
Eventually, Dias moved into a Stowe building owned by Residential Resources Inc., a Downtown nonprofit that specializes in housing for people with disabilities. Jeff Lengel, the nonprofit's president and CEO, said the building has been leased to Mercy Behavioral Health at least since 2009. Mercy Behavioral declined to discuss the building or any services it offers there.
Ms. Lewis said the building operated as a group home, with at least one staff member present. She said her sister's room was unclean; that she was expected to cook for herself, though she didn't know how; and that she didn't think Dias got enough to eat.
While Ms. Lewis and Ms. Mitchell complained about the level of care provided to their sister, it wasn't clear whether Dias took advantage of whatever services were offered to her. Ms. Dickson said the former Mayview patients generally have the freedom to live as they want but noted that officials can intervene in an emergency. "When somebody gets to the point of being a danger to self or others, there has always been the emergency commitment process." In such instances, she said, the person would be committed to Western Psych or a community hospital.
But Ms. Lewis said her sister never was hospitalized after leaving Mayview.
At least three times, police in McKees Rocks and Stowe charged Dias with offenses such as loitering, disorderly conduct and possession of a crack pipe. One police report described her as an "admitted crack cocaine user and prostitute" who frequented high-crime areas.
Ms. Lewis said Dias had gotten off drugs but did carry a crack pipe, which she used to smoke tobacco she removed from discarded cigarette butts.
If she needed food or other basics, Ms. Lewis said, her sister might have prostituted herself. "What kind of choice do you have?"
District Judge Mary Ann Cercone of McKees Rocks tried to put Dias on course.
In December 2008 and February 2009, to resolve minor charges filed with Judge Cercone, Dias signed documents agreeing to see her probation officer regularly and to submit to therapy, drug and alcohol counseling, urine testing and other services from a special team at Mercy Behavioral Health. These conditions, unlike those of the community support plan developed for her before she left Mayview, were binding. She faced jail for noncompliance.
But it's unclear whether the agreements were enforced or the services provided, whether Dias lived up to the requirements or whether it all was too little, too late.
On Oct. 17, 2009, Ms. Lewis received a phone call with terrible news. Her sister had been fatally shot in the head and her body found behind a house on Third Street in McKees Rocks.
A case with few leads
Stereotypes aside, people with serious mental illness are more likely to be victims of crime than perpetrators, often because they're unable to perceive danger, said Michelle Farquhar, a Shadyside resident and legislative and policy counsel for the Virginia-based Treatment Advocacy Center.
Caring for this group can be difficult, she said, noting that many fail to understand that they're ill and that agencies across the country struggle to provide consistent service. Ms. Farquhar said a stronger involuntary-commitment law and increased use of court-ordered treatment plans could help Pennsylvania better care for those who struggle on their own.
While Ms. Dickson said county officials tried to find activities that former Mayview patients "were interested in or wanted to go to or attend"-- even helping one person take up bicycling to manage stress -- Ms. Farquhar said a serious mental illness can sap a person's motivation and interest in daily activities.
Dias died a couple of blocks from the places police often found her hanging out. McKees Rocks police Chief Robert Cifrulak said little information about the crime has come to light.
Though she got disability checks for years, Ms. Lewis said, her sister died virtually penniless, leaving little more than a couple of bags of clothes at the group home. A friendly funeral home and a crime victims' fund helped cover funeral costs.
Dias' obsessive-compulsive behavior included extended showering, and on one visit to her sister's home, she stayed in so long that Bob Lewis went down to the basement and shut off the water. She later explained to Ms. Lewis that it took a long time to wash the streets off her.
While tarrying in the shower recently, Ms. Lewis said, she recalled that conversation and began to cry.
She said she told her sister, "I'm sorry."
Joe Smydo: firstname.lastname@example.org or 412-263-1548.